Is the NHS really in crisis because of money — or because we are asking the wrong question altogether?
In this video, I argue that the central failure of the NHS is not underfunding alone, but the way illness itself has been turned into a consumer product. Chronic conditions now dominate healthcare, patient demand has exploded, and pharmaceutical profits shape treatment pathways, often at the expense of prevention, patient agency, and genuine cures.
I explore why GP consultations have doubled, how medical intervention can itself create harm, and why lifestyle-based prevention is systematically sidelined. I also ask the question no politician wants to answer: who benefits from a system that manages illness rather than reduces it?
This is a political economy critique of healthcare, not an attack on doctors or patients, and it challenges the idea that simply spending more money will necessarily fix the NHS.
This video is longer than average - but it's worth watching all the way through.
This is the audio version:
This is the transcript:
What is really wrong with the NHS? That's the question I want to ask because I'm going to put an idea to you. I don't think that everything that is wrong with the NHS is just about money. Money is important when it comes to healthcare. We know that we could spend a lot more on it and produce better outcomes, but what I'm going to suggest to you is that we aren't really asking the right questions about the NHS, and the biggest one of all is the question that nobody seems to ask, which is," Why are people sick? And who benefits from their illness?" That's what this video is all about.
Every NHS debate has the same broad themes. We always seem to start by saying, "Are we funding the NHS enough? And are we allowing properly for medical inflation in the increase that the NHS has got this year?" And then we move on to other things like, "Is the NHS allocating its resources correctly between hospitals, GPs, and social care and so on?" And of course, inevitably, the question is raised, "Is NHS management efficient enough?" And I'm not disputing that all of these are important questions, but they all miss something fundamental.
The question we never ask is the most important, which is, "Why are people turning up in record numbers at the NHS?" And I'm not talking about record numbers because our population has grown. I'm talking about the fact that people are turning up more often per head of population. Why are so many people ill in other words? And that gives rise to another question, which is, "Are the treatments being given actually making people better?" These questions aren't asked, and that silence matters.
Now, let me be clear about what I am not talking about. Let me be absolutely abundantly clear that I'm not talking about accident and emergency services in this video. Nor am I talking about crisis and extreme medical events like heart attacks, broken legs, and everything else. And I'm not talking about end-of-life care, or even early life and maternity care, because these are essential, universally needed, highly valued by patients, and are not attractive to private providers because the profits inherent within them are always going to be low. They're core to the NHS and quite simply, by and large, they work well. They could work better if some of the things I talk about in the rest of this video were to happen. But the reality is, these are not the issues of concern. Nobody thinks that this is going to be done by anybody but the NHS in the future.
So let's just talk about some facts, some of which represent good news and others of which just represent the reality of the NHS as it is. We do, for example, have a population that is larger, and therefore the total number of deaths amongst those in the population is also increasing. That's an inevitable fact. The baby boomers are reaching the end of life. It's going to happen, it's inevitable, we can't pretend otherwise, so we will spend more money on that, but there are other reasons why spending could be falling.
For example, the proportionate birth rate is declining; therefore, less is being spent on early life care proportionally.
And some genuine medical emergencies are now declining in severity; for example, people now survive heart attacks when at one time they rarely did, so there are reasons for celebration in some of these things, or at least to recognise reality in others.
We should also recognise that NHS funding has grown. So we could then say there should be no crisis then, but we know there is. So why is it that the NHS is under such pressure? And my answer is that the real pressure point is something quite different, and that is patient demand.
Broadly speaking, GP consultations per patient on a GP's list have doubled this century. They were roughly three per patient per annum, and they're now heading for six per patient per annum. This will vary between doctors, it will vary between practices, and it will vary by parts of the country, but the fact is that people are seeing their doctors far more often. It's not that we are hypochondriacs; something else has changed, and as a result, waiting lists have also exploded.
And, if we see doctors more often, GPs will refer more people to hospitals because uncertainty will require that they do so. GPs can't do everything; they have to get second opinions, and that is why they make referrals to hospitals. It's not because they're lazy, it's not because they don't know, it's because there is detail that requires exploration.
But there's another reason why GP consultations have risen enormously, and that is because the management of chronic health conditions has now come to dominate their lives and NHS activity. That's why I made all those points about the emergencies and inevitable life events which create NHS demand, which we aren't talking about in this video: chronic conditions are, and precisely because they are chronic, ongoing medical situations, this is about ongoing medicalisation of life as it is.
Healthcare has now become a consumer product. I don't think it's possible to overstate the importance of this. Until the 1990s, the idea of healthcare as a consumer product didn't really exist, and then the Tories introduced something called the Patient's Charter early in the 1990s, declaring that every person had a right to service from a doctor who was going to meet their needs, whatever might happen, and that Patient's Charter changed expectations.
Patients acquired a right to intervention even when the best clinical option might be to do nothing, and the pressure on a doctor to do something became extraordinary, or the patient complained. As a consequence, demand for interventions grew exponentially. That one thing, created by John Major, changed the whole focus of emphasis inside healthcare. It became consumer-driven.
Demand for drugs increased.
Demands for tests increased.
Demand for interventions increased.
Demands for referrals increased, and the number of false positive test results that were created as a consequence then created the need for yet more interventions. A false positive is when you have a test for something, and the test comes back saying you've got it when actually you probably haven't. In some cases, the rates of false positives are very high, for example, with regard to prostate cancer.
Demand became self-reinforcing, and medical harm did as a result rise. I have to emphasise this point. Medical intervention can itself create medical harm. The compensation for that medical harm now costs the NHS billions of pounds a year; the biggest focus is upon childbirth, but by no means is that the major part of all claims when they're added up. All sorts of claims have risen, and that's partly because, and we can look at the data on this, the number of people who are admitted to hospital because of a medically created crisis is between one in twelve and one in ten of all admissions. In other words, one person in every twelve to one person in every ten who turns up in hospital is there precisely because, almost certainly, their drugs failed them and created a problem rather than a cure. This is not a marginal failing. This is a systemic failing, and that's creating additional demand as well.
So, let's just ignore money for a moment. Let's pause the funding debate and let's ask instead, " Do all these people really need all of these medical interventions? Are outcomes genuinely improving as a result of them? Or are we expanding illness as a product in its own right rather than reducing it?" And that's the point I want to emphasise here. Are we expanding illness as a product rather than having the NHS try to reduce it? Because it seems to me that, in fact, the NHS is manufacturing its own crisis by creating long-term chronic illnesses to manage.
We have to then ask, "Why is it doing that?" And I want to use some examples, and I've taken some medical advice before doing this. I should add that I'm married to a retired GP.
The first example in question is statins. These are the most prescribed drugs in the UK. Most people who look like me, of my age, with this colour hair will be on a statin, and statins are prescribed to manage cholesterol. Cholesterol is easy to measure, and it's found around damaged hearts. So a theory emerged that cholesterol must cause heart attacks. There is actually no proof that this is the case, and anyway, correlation is not causation. Firefighters are always found at fires; that does not mean they cause the fires. Likewise, cholesterol may be found when a person has had a heart attack; it doesn't mean that the cholesterol caused it. In fact, the evidence suggests that while statins help after a heart attack to manage the risk of a further recurrence, the way they are given out as preventative medicines to large numbers of people in the population is questionable.
It has been estimated that, on average, a person might increase their life expectancy by three days if they take a statin during much of their later life, and I have friends who've been on these things since their forties, and I think they'd be a bit shocked to know they've added three days at the end of their life when they might already have dementia anyway. So the point is, do they work? We don't know. What we do know is that cholesterol is not the enemy. Around 90% of all cholesterol found in our body is produced by us in our bodies. What we also know is that the organ that uses the most cholesterol is the brain, and low cholesterol is actually linked to dementia, diabetes, and some cancers, and so the trade-off matters. You get three extra days of life, you take the risk of these other things.
But in the meantime, the NHS has parted with £100 million a year to buy statins, which are admittedly a very cheap drug in themselves. But prescribing them is the real cost. There is GP time. There's repeat prescription time. There's pharmacy cost. There's side effect management. There's hospital admissions arising as a result of unnecessary taking of statins, and none of that is counted. This is a real cost; now, I'm not saying give up your statin without medical advice. Please don't presume that I'm a doctor because I'm not. I'm just saying this is what a calm analysis of the crisis within the NHS suggests to be a problem.
Follow the money. Statins generate enormous pharmaceutical profits. They might be cheap, but there's a massive profit margin within them. And repeat prescriptions become predictable revenue for the pharmaceutical companies, so they love them. Chronic dependency is, in fact, the most profitable thing that they can create. And remember, they're profit-driven businesses and therefore the fact that they've got the country hooked on statins is not accidental, it's deliberate.
Let me look at a second example. Look at type two diabetes. Type two diabetes is fundamentally different from type one diabetes, and I know that not all forms of type two diabetes are the same, so this is a general overview, and again, it's not medical advice. Don't do anything as a consequence of this video without going to see your doctor, who will probably tell you that what I'm saying is a load of rubbish. But type two diabetes is largely about something called insulin resistance. Insulin is part of a messaging system. A person with type two diabetes does not have a shortage of insulin; what they have is an inability to pick up the message from insulin. So what do we do? We prescribe more insulin, and in fact, there are risks to this.
There is an obvious alternative to giving type two diabetes sufferers insulin. We could instead tell people who've got type two diabetes that the condition they've got is curable. They don't need that excess insulin to send a message to their body. What they need to do is change how their body behaves, and that means they should consume less sugar, less ultra-processed food, less alcohol, take more exercise, be out in the light more because the light helps the body absorb the goodness out of food and resists the sugar overload that comes otherwise.
Overall, the message to people with type two diabetes is, "If you want to be better, change your lifestyle." But is that what patients are told? No, it isn't. By and large, instead, some, but not all, patients are made insulin dependent, usually for life, with repeat prescriptions, with escalating interventions, and this again sustains pharmaceutical profits. And incidentally, it keeps politicians very happy because those pharmaceutical profits and all the activities around them feed into GDP. But at the same time, that growth does not measure an increase in well-being because, in fact, the patient is no better. They might be worse, and their agency has been removed. They've just become a cog in the medical pharmaceutical industry, and that is really worrying when, in this case, a great deal of this illness is reversible.
We could manage chronic illness by eliminating it, in this case. We don't because that would remove the pharmaceutical industry's profit stream, and that's again, something that really scares me, as did something else I saw recently, and that was on cancer treatment.
There was a programme, Stand Up to Cancer, on Channel 4; they do them quite often, and they invited us to join a patient in their surgery meeting with a doctor about their breast cancer. The woman in question had been diagnosed with a lump in her breast. She'd had a lumpectomy. The lump had been removed. She went to see her surgeon, and her surgeon was able to tell her, "You are now cancer-free," but then, deeply confusingly, the patient was prescribed radiotherapy, and she was told she would have to take a deeply toxic drug for up to five years to manage the risk of cancer.
And you could see her confusion; at one point, she was absolutely delighted, "You are cancer-free," and then she's immediately told, "Well, despite the fact you are cancer-free, we're going to blast you with drugs for five years. And with something deeply toxic called radiotherapy, which really is not good for your body's immune system," and her confusion was rational, and nothing was done to alleviate it.
Why did a doctor want to continue the intervention when, apparently, the disease that the person was suffering was cured? Because continued intervention keeps the patient in the system. It generates pharmaceutical demand. It normalises dependency. This, in my opinion, was not patient-centred care. It was pharma-system-centred medicine designed once more to keep the person taking the drugs. Whether there's a benefit or not was not discussed; what the side consequences were was not, as we saw on the screen, discussed; it might have been elsewhere, but was not on screen.
Why were the natural interventions that can manage cancer risk not discussed? And they're remarkably similar to those, by the way, for type two diabetes: cut out the ultra-processed food, cut out the sugar, cut out the alcohol, take more exercise, go outside more, do more cold water immersion. All these things have proven medical track records of success in preventing cancer of the sort that the person in question had recurring. But that wasn't mentioned; it was just "You will take a drug." The alternative was not discussed.
In that case, why is patient agency so weak? And why does the government stay silent? Because surely the government should want to cut costs by asking these questions. But they don't because pharmaceutical activity boosts GDP, and GDP growth is what governments want above all else. And chronic illness sustains growth, bizarrely, and regulation would reduce profits.
So the NHS has become a delivery mechanism for what is, in effect, pharmaceutical industrial policy. Patients are just the cogs in the machine. We were once the subject of healthcare, but we are now just units of demand to consume the products created by the pharmaceutical industry, supplied to us via the NHS. The NHS is, in fact, being used to manufacture and sustain chronic illness rather than to try to cure it.
We could, of course, have a different NHS.
We could have an NHS which tried to prevent excess treatment.
We could present patients with alternatives.
We could talk about managing symptoms rather than providing uncertain chronic management programmes.
We could, as a consequence, have an NHS which was much smaller.
We could have an NHS which was more effective.
We could have an NHS focused on genuine need.
We could deliver better outcomes.
But we could only do all of that if the government acts and actually asks the question I suggest, which is, "Why are people turning up to ask for healthcare?" They aren't: they're turning up to get another dose of their chronic illness management system.
So to challenge this, we need stronger regulation of pharmaceutical companies.
We need an honest discussion of treatment efficacy.
We need investment in prevention and not pills.
And we need to restore patient agency whilst rejecting GDP-driven health policy.
The NHS is not failing because of money alone; it's not helping with the system we've got, but it's failing because illness has been commodified, prevention has been sidelined, profit has replaced care, and until we confront those facts, no funding model or increase will be enough. Big pharma will always want more, and that's true whether we have a continuing NHS model or, frankly, a move towards a private-based system, where, as we can see from the USA and other systems, the degree of medication will only increase.
We are living in a world which is asking the wrong question about healthcare. The question is not "How do I manage my chronic condition via medication?" It is, "How can I cure my chronic condition by changing my lifestyle?" That is the simple change that is required to manage the crisis in the NHS, and so far, no politician is talking about it, and they should be because this is about the political economy of power.
I'm interested in the power of being with the patient. Our politicians are interested in the power being with the big pharmaceutical companies. The NHS sits between the two, and the NHS should be supporting the patient, but at present, it's supporting the big pharmaceutical companies. We need to change that balance of power. Patients must come first, and if they did, we'd have a very different and much more successful NHS as a consequence.
What do you think? Do you think there are better ways of managing healthcare? If so, have a look at the poll down below.
Poll
Loading ...Taking further action
If you want to write a letter to your MP on the issues raised in this blog post, there is a ChatGPT prompt to assist you in doing so, with full instructions, here.
One word of warning, though: please ensure you have the correct MP. ChatGPT can get it wrong.
Comments
When commenting, please take note of this blog's comment policy, which is available here. Contravening this policy will result in comments being deleted before or after initial publication at the editor's sole discretion and without explanation being required or offered.
Thanks for reading this post.
You can share this post on social media of your choice by clicking these icons:
There are links to this blog's glossary in the above post that explain technical terms used in it. Follow them for more explanations.
You can subscribe to this blog's daily email here.
And if you would like to support this blog you can, here:
Buy me a coffee!
Given the issues over winter pressures with an ageing population exacerbated by poor housing might I suggest that we dont need Doc Martin we need Bob the Builder – one for every GP surgery
Is this another indication of what I suspect,
Are we living through a corporate Coup d’etat?
Where corporations have control of nations and not government.
Sure seems that way.
There was a suggestion that of we had retained the £20 pw increase in Universal Credit during Covid it would have significantly reduced the number of mental health consultations
Very good post. “correlation is not causation” Glaxo & Zantac aganist stomach ulcers (= reduce acid or some such). My understanding is that heliobacteria are the main cause. Agree, looks like a combo of keep big pharma in business and keep patients in the system (which is very similar to people seeking asylum who are locked up – for no good reason – but hey profits).
‘Commodifying illness’ – quite correct and terrifying to be honest.
What was that quote about only I.T. and drug dealers calling their customers ‘users’? Some services on the NHS as well. And the terrible thought that something is only worth having if you can only exploit it? What sort of mentality is that?
I attend a regular clinic to do with managing wounds/ulcer on my leg and have to say that advice about lifestyle is constantly talked about and encouraged. Leg ulcers do happen even if you are active as I am, on and off as I have them. At work we are actively encouraged to get up and walk about, also putting your feet up. The advice is there.
I do not think that the culture of treating patients as ‘customers’ has helped, bringing into the service an element of passivity – the customer ‘is always right’ – less judgmental, less interventionist, more diffidence – although under funding/under resourcing might also cause this.
A powerful post.
Thanks
I have often thought that what is really needed is a national health survey. Where it is used to determine the overall health of the nation. This information would then be used to work out the NHS strategy for guiding the nations health. Furthermore, we need to BAN bad “foods”, ultra processed, high fat, sugar, etc.
The immediate reinstatement of a PROPER national dental service. So many diseases would be prevented for even beginning if this was instituted. The same for podiatry, eye care etc. A national strategy to get the nation fitter, look upon every high street, the number of unfit, unhealthy, chronicially people struggling to get around is astonishing. Therapy both physical & guidance would help hugely. There is so much we could do to make our nation healthier & happier. healthier would cost less in the long term, happier would make for more satisfied population, possibly less prey to extremism, self harm, addiction etc. I of course could be wrong…
You’re not…
Yesterday I had my first appointment with a dentist who is new to the practice. He started by commenting that I was very unusual. Why? Because he had noted that, at 82, I am not taking any prescribed drugs. Nor any unprescribed ones, I hasten to add!
I replied that it shows how pervasive and powerful the pharmaceutical industry is in modern society.
I didn’t know you would be talking about this very subject today. Clairvoyant or what?
My wife (a retired GP would confirm that).
I am also odd in that respect. At 67 she would expect a normal man to be on about ten precrip[tion drugs. She heavily informed this morning’s video.
I just take coffee and the occassional gaviscon.
Like you, at 67 I was taking no prescribed medications. But that was at 67. 10 years ago, at 71 I suffered a heart attack, and now I’m taking a cocktail of drugs on a daily basis mainly to keep my blood pressure down from astronomical heights. I am satisfied that my own GP listens to me because one of the drugs prescribed by the heart surgeon was atorvastatin. I researched that drug, including reading the book “A Statin Nation” by Malcolm Kendrick, and he (my GP) agreed that surgeons tend to prescribe the strongest dose possible, which might be causing my lack of energy. He reduced the strength to the minimum, which cured the problem. So don’t be too pious, Richard, you wait…
BTW, I was discussing with my GP a couple of days ago the fact that it took 7 weeks to get an appointment and suggested it might be the lack of his funding from the government. He said that is so, but that demand has grown exponentially. I said my research had elicited that nearly 50% of GPs are unable to find work, and he said that it is outrageous that we spend hundreds of thousands on training a GP, then don’t provide the funding to employ them, so they are all going to Canada and Australia who get to benefit from our spending on the training.
Thanks
I only take Ezetimibe as an alternative to a statin, which I declined when they suggested I start on them, which must be good going for a 68 year old.
I am a rock solid believer in the principle of the NHS but recognise that neoliberal politicians of all major parties have undermined it and continue to do so.
I am also a firm believer in the principle that we have a responsibility to keep ourselves healthy and act on whatever sound knowledge and advice we have access to.
Continuing with the neoliberal theme, we can see its tenets and principles causing all manner of chaos these days in all spheres of activity, and I really mean all.
Agreed
After immunotherapy treatment for kidney cancer, I must now take hydrocortisone for adrenal insufficiency, but before that I avoided all prescription drugs. I have warned many people of the poor efficacy of Statins. The data supporting wide-ranging long-term Statin use is very poor: so I suggest they check out the ‘Number Needed to Treat’ which reveals how many patients would need to be treated with the drug for a single patient to benefit from taking it. For Statins that number is shocking, but other drugs can also be evaluated in this way.
Another study is now out suggesting there is no benefit from statins – this week
On the omnibus, it’s quite scary how many are now taking or about to start taking weight loss drugs, Ozempic etc.
Obesity is a massive issue, the bus can hardly get up the hills, pre-diabetes, type 2 diabetes, osteo-arthritis, heart problems and bowel/liver cancers, all related to obesity – and of course behind it all, UPF – cheaper than real food and promoted with unregulated advertising.
I don’t understand why it’s illegal to put arsenic or strychnine in food but loading it with sugar, & salt, while removing fibre and vitamins and minerals, is absolutely fine, and spending billions on advertising it is an allowable business expense.
Sadly, there doesn’t seem to be a profit to be made out of hammering UPF consumption (except that it would save the NHS billions, get millions fit for work, and increase general well-being, but that’s not “profit” so who cares?)
Much to agree with
This is what I am getting at. If you think that your job is to just make people happy by finding novel, easy and relatively unproven ways to get around problems they have created, then you will never tackle the fundamental cause.
The weight loss drugs are a case in point. It avoids tough questions like ‘What are eating? How much of it? How often do you do something physical?’
The drugs act as a palliative – nothing more – a smoke screen against reality. This is wrong. Because it is not about making people happy; it is about making people well.
And if you are making an enemy of your future, you need to be told, because it soaks up time for people who have genuinely become ill largely because of some factor beyond their control, never mind the impact on your loved ones.
So I do get and support the general thrust of your comments the NHS. The service should be doing more than just funnelling people to big pharma.
And these drugs won’t work unless taken for good – with major side effects.
I enjoyed the video. Read Dr Malcolm Kendrick on cholesterol, he also has dug out some info on salt, mentioned here on his blog:
https://drmalcolmkendrick.org/ He is talking about disruptive science and may be one who would describe himself as an unreasonable man.
Interesting to have an overview that shines light on the drugs spending in relation to scrimping elsewhere, and on the place of preventive care of which not much is offered. Thank you
So in effect you are saying the pharmaceutical management of chronic illnesses better managed by lifestyle changes is a major cause of unnecessary effort and cost within our NHS?
Everyone I know who has been prescribed statins complains of horrible side effects and I’ve long been unconvinced of their benefits in elderly patients.
You haven’t mentioned long term use of anti depressants which can have horrible side effects and very dubious benefits, currently taking by millions for many years. NHS Talking Therapies was supposed to reduce this, but their insistence on CBT rather than just listening is unhelpful for many. I know this is controversial but a more human approach could save millions and be much more helpful. Social prescribing is valuable but I hear they are often overloaded with high caseloads.
Much to agree with
I am unhappy with how many of these chronic diseases need a doctor’s input to tell you how bad they are. High blood pressure, high cholesterol, diabetes blood sugar level and its implications, are all things you cannot observe for yourself, by how well you feel. Yes, you can buy kits to measure these things at home, but that’s not the same. I was diagnosed as diabetic 25 years ago; I have felt no ill-effects, though my medication has gradually been increased. I wouldn’t have known there was anything wrong if a doctor’s visit hadn’t included a blood-sugar test. And, incidentally, I suspect that the rise in diabetes II is partly connected with the decrease of test prices.
Interesting idea
What you say makes sense. I did listen to the end and close promoted a very simple and low/no cost change. A 2-part prescription. The first, remains unchanged. The pharmaceutical prescription. The second would be for the patient. A life-style change prescription.
I know this is may be given verbally during an appointment but words alone are not enough.
There are lessons from the Japanese health systems which transformed mortality rates in the post war years. Not by spending money which the economy did not have but through a system of regular health checks at population level where people where provided personalised lifestyle changes.
More than “what can I do to cure my chronic condition by changing my lifestyle”, “What can the government do to prevent people developing chronic conditions in the first place”?
Indeed
“Why did a doctor want to continue the intervention when, apparently, the disease that the person was suffering was cured? Because continued intervention keeps the patient in the system…..This, in my opinion, was not patient-centred care. It was pharma-system-centred medicine designed once more to keep the person taking the drugs. ”
So are you advising people in that position that they don’t need the treatment?
Tell me why they do need treatment when they do not have cancer?
The burden of proof is on you.
I am surprised thst the cancer consultant said the women no longer had cancer aka the “all clear’ so beloved of daytime tv shows.
Oncologists are generally careful to say that there is no evidence of disease (NED) on the the day the person was examined i.e. the patient is in remission. Not all clear.
Cancer treatments are improving – more effective, less terrible but we still need them.
Why do we need them as blanket solutions when the evidence that other options are at least as effective – and I mentioned some – exist, are cheaper and have postive side effects?
What might be the purposes/reasons for what might be termed “Wellness Self Care” not being prominent in the National Curriculum?
It would be interesting to know just how many investment fund managers had pharmaceutical companies in their portfolios and how they have performed over the last twenty years or so.
I sometimes think that the problem with the NHS is its name – it might better be called the National Sickness Service, it seems more concerned with sickness than with health.
And I am reminded of the opening chapter of ‘Three Men in a Boat’, in which their ill-health is discussed: the rest of the book relates what they do about it…
I recommend a book I am reading at the moment.-‘ The political economy of health care, where the NHS came from and where it could lead’, by Julian Tudor Hart, who was a well-known GP in a South Wales mining community for 30 years.
Disclosure: I am a UK GP of 30 years and continue to work in the NHS. I have also worked in Africa (predominantly private provision) and New Zealand (a mixed insurance and social funding model).
In response to the question “what is wrong with the NHS?”, my view is that its core structural issue is that it operates as a centrally managed monopoly with limited competitive or financial feedback. Decisions are often made by non-clinicians, with weak links between responsibility, incentives, and outcomes — a classic moral hazard problem.
Over the past two decades, NHS management numbers have increased substantially, without clear evidence of proportional gains in productivity or health outcomes. International comparisons suggest that the UK underperforms comparable mixed systems on some key metrics, including timely diagnosis and treatment, particularly for cancer.
No healthcare system is without trade-offs. However, some economic fundamentals are unavoidable. Demand for healthcare is effectively unlimited, and when services are free at the point of use, scarcity must be managed administratively rather than through price or choice. This tends to generate waiting lists, rationing by delay, and misallocation of resources.
In general practice, many current pressures date from the 2004 contract, which increased central control over what are formally independent contractor practices. GPs are not salaried employees but small businesses, largely dependent on NHS income and required to follow nationally determined targets and guidance. This limits local autonomy and innovation, and makes practice behaviour largely policy-driven rather than market-driven.
The Covid period illustrated these dynamics clearly. Efforts to protect system capacity reduced access for non-Covid illness, with subsequent increases in late presentations of serious disease. This reflects system design rather than individual failure.
My conclusion is not that the NHS should be dismantled, but that gradual structural reform is needed. A mixed funding and provision model — including tax relief for health insurance, expansion of non-state provision, and limited cost-sharing — would introduce opportunity costs, improve allocation, and reduce avoidable demand. With an ageing population and increasingly expensive therapies, the current model appears fiscally and operationally unsustainable in the long term.
I appreciate your work and the way your writing encourages critical examination of healthcare policy.
Please forgive me, but many of your claims are simply wrong.
The problem with the NHS is that, compared to almost any other healthcare system, it has too few managers, by government choice, and those it does have spend far too long managing a fake marketplace, with all the resulting distortions and inefficiencies.
It also has too few hospital beds, again by government choice.
And many of its hospitals are hopelessly derelict.
Alongside that, your claims about GP practice are also wrong. First, private equity is entering this market. Second, GP practice has been badly damaged by fundholding arrangements that have allowed far too many older GPs to cream off profits whilst denying opportunity and hope to younger prospective GPs, who are worked to the bone with limited chances of progression.
The neoliberal cost model of government, the faux market model imposed on the NHS, and the greed of some GPs are all major issues for the NHS and need correction. The last thing it needs is more marketisation, as you suggest, no doubt in the hope of personal gain.
You may well, in other words, be what I suspect is the problem, and not the solution.
We probably agree on more than it might first appear, Richard — and thank you for engaging (and for what it’s worth, we’re both in Sheffield).
I’m very happy to debate structures and incentives, but I do want to push back on the suggestion of personal motive. I’ve spent 30 years working in the NHS, including seven as a GP partner, and I continue to work in it now. My interest here isn’t personal gain, but what actually improves outcomes and sustainability, based on experience rather than theory.
I agree that the neoliberal cost-control model and the faux internal market imposed on the NHS have created serious distortions. But that isn’t the same as saying that accountability, choice, and feedback mechanisms are inherently harmful. What we currently have is neither a true market nor a well-run public service — it’s a hybrid that diffuses responsibility and protects failure.
On GP practice specifically, I don’t see private equity entering general practice at scale in the way it has in dentistry or veterinary medicine, and I’d be genuinely interested in evidence on the size and impact of that trend. Nor do GP partners “cream off” profits. They earn them by taking on clinical, financial, and organisational risk — and when they fail, practices close.
I’ve trained many younger GPs, and many understandably prefer salaried roles because partnership now routinely means 60-hour weeks alongside running a small business. Partnership roles do exist, but uptake is low, largely because the volume of paperwork, compliance demands, and centrally driven mandates now shape patient care — with clinicians forced to serve the system first and patients second. This is my bread-and-butter work, day in and day out: trying to make an inflexible, static system respond to individual patients’ needs.
I agree we don’t need more of the current faux-market model. But doubling down on central control hasn’t worked either. Systems improve when failure is visible, success is rewarded, and there is real feedback from patients and professionals.
Reasonable people can disagree on remedies. But the real dividing line is whether systems improve by insulating failure — or by attaching accountability to responsibility and outcomes.
Thank you for confirming that what I said was appropriate, including that the current GP model is failing, as it obviously is. You describe that failure yourself. The answer is to make this a salaried service, integrated, as it should be, with hospital, mental health, and ambulance care, and closely linked to social care within large regional health authorities, while cutting out all the rest of the nonsense we now have. Make it clear that doctors deliver care and politicians deliver resources – and if medics can do no more in a day, they close and say that politicians must solve the resource issue. Your job as it is, and the fiasco of it supposedly being a small business, should go, as should QOF, which privileges pharma-algorithm-driven medicine.
But let me turn to your surgeries. Most of your time, you will be managing chronic illness and prescribing drugs that are probably useless. A new European paper this week says precisely that of statins, highlighting their limited benefit alongside harmful side effects. Why do you think that is useful? Why don’t you question the system? Are you sure you do not do harm at least as often as you do something useful? How do you know when profit is your motive, requiring compliance with big-pharma-driven protocols, and when the algorithm-driven GP model is an antithesis to critical thinking, with general practice having been deprofessionalised as a result?
I’m entirely with you on this, Richard. I commend you for keeping your rag with the good doctor and respecting his position in life. I assume your wife did read and support your comments.
I did some research a few years ago on the ownership of GP practices, but it is pretty much impossible to do so because, as far as I could ascertain, their structure is not transparent like, for example, Tax Research LLP whose ownership details and accounts are available online through Companies House. There was a suspicion that GP surgeries were being bought up by US healthcare companies and certainly 60 were. However, due to discomfort about this situation, the US company, Centene Corporation though it’s subsidiary, Operose Health, relinquished their interest. But to whom? Private equity group Twenty20 Capital. Who, of course, are only interested in returns for their investors. So I’m not sure I’m any more comfortable with that either.
I never understood why the founders of the NHS ever let GP surgeries continue to operate as independent entities. As you so rightly, in my view, say GPs should be salaried and working for the NHS.
Not directly related to the NHS but very much related to the subject – the book “how not to die” is an interesting read.
https://us.macmillan.com/books/9781427268105/hownottodie/
It starts with a list of the top 15 killers (in the US?) – heart disease, cancer, diabetes…. Etc and shows how changes to diet can significantly reduce risk. Ideally we should continue to increase taxes on ultra-processed and high sugar foods in the same way that we have on cigarettes and alcohol, in order to fund the effects that we pay for via the NHS, while at the same time hopefully reducing their consumption.
I remember you have talked about this in the past, Richard…
What a fantastic post.
I have followed Malcolm Kendrick’s blog for about the same length of time as I have yours. You both refuse to accept the “received wisdom” of the establishment – medical, economic or political, and both offer a meticulous analysis of the issues and carefully researched and well argued alternative perspectives. I would highly recommend Malcolm Kendrick to your readers, though his blog is less frequent these days. Health, he says, is composed of three components: physical, psychological and social. His advice in a recent YouTube video included: get outside and walk, especially in the sunshine, eat meals that you have cooked yourself and enjoy them in a calm and peaceful atmosphere rather than making them simply a refuelling exercise; take care of your relationships and build an active social life, e.g. join a club. In the words of Bobby Mc Ferrin: Don’t worry, be happy.
I would add “take up singing”
🙂
Couldn’t really believe it when I heard about the weight loss drugs – but then it was obvious this was the way it would go. As Richard says – its the NHS prescribing drugs which boost big pharma profits instead of tackling the root causes of obesity – especially ultra processed food which contain ‘drugs’ to keep people eating :
https://www.vitabright.co/blogs/health-hub/review-ultra-processed-people-by-chris-van-tulleken-the-ultra-processed-food-book
It is difficult not to despair – we know Labour Tories Reform now depend entirely on their big business / foreign donors, so obviously government is never going to ban ultra processed foods.
As to NHS structures – as recently as 2010 an OECD survey rated NHS satisfaction top of all countries , but now in the throws of a crisis – which Streeting chooses not to see or deal with.
We have no idea what wave of health crises these drugs might be unleashing. We do know there are serious side effects. We know other treatments are available.
Thank you for a thought-provoking article, and one which has stayed in my mind while I was doing other things today which is why I am responding so late.
Your observation that patients’ expectations of the health service have changed is important. But why is a tough question to answer. The pharmaceutical industry does play a role in its own interest but isn’t the major answer, interestingly all the examples you give involve generic drugs which are cheap and provide too small profit margins to be promoted by the big companies (who probably no longer make them anyway). The issue is a culture change where medicine is assumed to have absolute answers: do this lab test to get the diagnosis, prescribe this drug (or do this operation) to cure. Actually the most important information comes from a doctor using his or her expertise to make an informed judgement (the most important information probably being from talking to the patient) and any treatment depends on their judgement of the benefits and risks (informed by an extensive scientific literature) of different options for that patient.
To take your specific examples.
Statins. There is in real life an active debate about prescribing statins, with single patient benefit being small but side effects rare (current practice is to prescribe when for every person spared a potentially fatal cardiovascular event about 99 would have been OK anyway). How do you judge the balance? You suggest any benefit might be while suffering dementia anyway, but actually there is reasonable* evidence that long term use of statins significantly reduces risk of dementia.
Type 2 diabetes. Your example is someone on insulin, but insulin is only prescribed when the condition has progressed too far to resolve by lifestyle alone. Alterations to diet and exercise definitely should be the predominant approach on first identification of symptoms, and it is possible current GP culture is to go too soon for the usual drug approach (metformin).
Breast cancer. It is very surprising any doctor described a cancer as “cured”. No one can know if there are residual undetected cancer cells to cause a recurrence. Following breast cancer surgery treating with a drug (tamoxifen) that prevents any remaining cells dividing, until they are likely to have died, has been shown in clinical trials to save lives.
[*Only “reasonable” because it is observational rather than from prospective clinical trials, but with some biological credibility].
Jonathan,
I know you have expertise in this area, but the statins claim is disputed, and I accept that it is not agreed either way, but there is a lot of support for the opinions I offered.
You suggest an ideal type 2 diabetes scenario. The problem is that this is not what happens in practice.
And on breast cancer, you are right that no one is ever cancer-free, even if we have not “got it”. But tamoxifen is a nasty drug and is by no means the only way to prevent remaining cells from dividing, as I mentioned. The real question is controlling why they divide, and that is also possible.
But ultimately, I suggest that you miss the point. GP QOF algorithms, mosyt especially, basically require prescribing, so prescribing takes place. Judgement is suspended. GPs who do not meet the algorithm do not remain financiallly viable GPs for long. Your assumption that clinical judgement is being exercised is where the mistake lies. The system has been captured – and that was my point.
Richard
I agree, the QOF reimbursement system is perverse. It directs GPs to favour prescribing drugs directed at improving proxy markers of disease over promoting better health through lifestyle.
There is a real controversy over use of statins, with lively discussion in the medical press. Intriguingly there is rarely mention of the benefit in reducing risk of dementia; once again though that is measured as a population improvement and there is no way of telling whether an individual patient will benefit.
You are aware that an increased risk of dementia is an advertised side effect from statins? It is, I gather, in the BNF, along with joint pain, sleep disorders, liver disorder, memory loss, pancreatitis, depression, diabetes, lung disease, and neuro muscular effects ( which could include dementia, I am told).
See https://www.health.harvard.edu/staying-healthy/do-statins-increase-the-risk-of-dementia
Your case is, at best, not proven.
That was a very thought provoking post and informative to read – thank you. If it was truly a national health service – then it would be concentrating on peoples health through the many a time mentioned diet and exercise route.
Although I think poorer people tend to have worse health outcomes than richer people over a lifetime, I suspect that the resource of time is more significant than money as if you don’t have time because you are chasing money then your health will be on the backburner. I guess that would apply whether you are richer or poorer (perhaps with the exception of those with active jobs).
Lack of time not only means no time to exercise, but also falling prey to the aforementioned Ultra Processed Foods, many of which contain suspected carcinogens as well as the poor macronutrient profile.
Not to mention the stress of trying to make ends meet on a daily. Our mood and how we are thinking has major influence on the rest of the body and therefore health – whether good or bad. I think even medical science acknowledges this, otherwise what is the point of a placebo.
Our connection to other people (being social animals) also has a huge influence on health.
(Un)fortunately I have seen a GP once in the last 2 decades as I don’t have a smartphone, but I wonder whether the movement towards AI and virtual health appointments does more damage through loss of the relationship between GP and patient than it saves from lack of exposure to infectious disease.
Therefore perhaps if the NHS had not only hospitals for the sick but gyms for the well, social clubs for all and even large gatherings like music, arts and interactive theatre then the population of this country would be happier and healthier.
Also many people complain of the arts being chronically underfunded – if the NHS was used as a bedrock of health through social connection, then small businesses and charities could partake too and ‘crowding in’ as you mentioned in a previous post could take place.
Good insights.
A good omnibus questionnaire that would correlate well with adverse mental and physical health outcomes would cover:
Total household income, any arrears on utility bills, council tax and credit card, overdraft, how many jobs (that question doesn’t work for George Osborne), hours worked per week including commute time, and whether by private or public transport, bus or train, how much holiday in the last year, their last day off, security of tenure in job and accommodation, shift or night work, composition of meals/snacks eaten in last 3 days, hours real sleep each night, posession of winter coat, last visit to dentist, how many close family or friendship relationships – you get the picture.
A totally different and painful set of questions for children, including – do you sleep in a bed, when did a parent last hug you, did you eat yesterday, when did you last have a clean change of clothes, how much time do your parents spend with you, are you in care? Etc etc.
The teenage offender in the recent double teen murders in my neighbourhood, had a horrendous abusive upbringing, and no amount of “cracking down on knife crime” would have altered that.
Does Wes Streeting care about this? Does he co-ordinate with other ministers to REALLY improve the nation’s mental and physical health?
I don’t see the evidence.
You’ve some things wrong here Richard. It isn’t true that GPs don’t recommend lifestyle interventions instead of drugs where appropriate, and will usually carry out joint decision making with patients especially where they are in a marginal band above normal indicators. Statins are probably the most researched drug category too.
I’m alarmed by your breast lump example – this presumably wasn’t benign but a primary tumour. The decision to offer adjuvant therapy – therapy after removing a primary tumour – is based on many studies of preventing early stage breast cancer from recurring, which it does in about 30% of patients and is a highly complex picture concerning the type and stage of the cancer. And researchers have been highly active in genomic studies that can tell if a patient can be spared adjuvant therapy.
As for the NHS, contrary to what many on the right say, it is very undermanaged for an organisation of its size, and of course also has current shortages and opportunities for resident doctors. We need more and better admin, better facilities and more frontliners.
I can assure you I have checked all I have said, and spoke and wrote with care.
The statin case is pretty clear now: there are many in the medical media who argue against statins, and some of course who disagree. This is a weighted balance.
The risk apprtaisal by most GPs is perfunctory. The risk is not.
And the breast cancer case was as I described on scrreen with no explanation of other highly effective (adn well documented) ways to manage risk being mentioned. Tht was my point.
What I said was said with care, anbd I do not think it was wrong. I think your claim is wro ng.
But if you think I am wrong might you tell me:
– How does cholestorol contribute to heart disease?
– How relaiblke is its meaasurement (when it is actually LDL that uis meaasured)
– What is the most likely cause of cancer and what is the best way to manage it in tht case?
I have looked at many medical papers and interviewed many experts in a professional capacity, especially in oncology.
I am very much in the camp of evidence-based medicine and that many medical interventions are of marginal or no value and are pushed on to the market by regulators accepting poor quality studies, often because nothing else has worked for deadly conditions.
But a lot of therapies are effective as confirmed in high-quality randomised trials.
Statins are such an effective class of drug and are very safe. I agree they are overprescribed and that not enough care is taken to discuss risk in healthy people with elevated LDL and other risk factors, particularly to highlight absolute rather than relative risk. There certainly is evidence that a lot of low risk people could come off statins.
Atherosclerosis is the main cause of cardiovascular disease and is caused by fat, cholesterol and other things so I’m puzzled why you are questioning the link.
I think you’ve misunderstood the cancer example. In a number of cancers, even the best surgery or other primary intervention can leave behind residual cancer cells, which may in any case have escaped the surgical margins. Cancer is rarely cured in everyone with most cancer types and recurs at high rates depening on grade/type in many people in common cancers such as breast, lung and colon. Adjuvant (after) or in some cases neoadjuvant (before) therapy have high quality studies showing recurrence rates after surgery can be reduced with radiotherapy and/or drug therapy that kill/control remaining cells or control hormones.
Of course in oncology there are a lot of poor studies and drugs, but that’s no reason to suspect the high quality trials incorporated into guidelines by cautious bodies such as NICE as standard of care do not work and improve survival and/or quality of life, as you might just as well say nothing works!
And yes, exercise, eating well, cutting down on alcohol etc do have evidence of benefit but for most things. I used to work in health promotion and of course we must focus more on health and wellbeing but if I have cancer I want to be offered the standard of care.
I offer these on statins
https://journals.lww.com/co-endocrinology/fulltext/2022/10000/statin_therapy_is_not_warranted_for_a_person_with.14.aspx#:~:text=Extensive%20research%20has%20demonstrated%20the,a%20low%20triglyceride/HDL%20ratio
And this https://www.health.harvard.edu/staying-healthy/do-statins-increase-the-risk-of-dementia
And this https://youtube.com/shorts/XOqZx9fs2bQ?si=dIHQIZWrSwTj9vc2 – I am assured this is very reliable.
Re the cancer example – I exactly got it. I know cancer is not cured. I know we all have cancerous cells all the while. I know the issue is how do we stop taking them over. I challenged the incorrect lkanguage in the film. What I was arguing was a) this and b) the lack of explanrtion and c) that the many studiss tht show that lifestyle chocies impact outcomes are NOT discussed, almost ever. We know this from personal experience. You have completely misudnerstood what I said.
And you have ignored that these options are ignored because of QOF.
And I would suggest, the standard of care is very often dangerous, as much evidence shows.
Thanks for this Richard. Do you have a link to or recall the name of the European study on statins? My doctor started me on them at age 81(my age) last year because I have peripheral vascular disease. I am not over weight, walk a lot, still working, drink very little alcohol, stopped using butter, don’t eat red meat, and get lots of olive oil. I like to have a discussion with her about that study, to get her views.
This may be the best study for you (I am told). https://journals.lww.com/co-endocrinology/fulltext/2022/10000/statin_therapy_is_not_warranted_for_a_person_with.14.aspx#:~:text=Extensive%20research%20has%20demonstrated%20the,a%20low%20triglyceride/HDL%20ratio
And maybe this. https://www.diabetes.co.uk/in-depth/aseem-malhotra-great-statin-con/
Or this https://share.google/P4wfLWNHqWyZb8jK1
David Byrne says:
Excellent and timely discussion on the NHS, and in particular General Practice and the profit motive.
The GP ‘small business’ as with other businesses is about profit maximisation including the sale of any other additional services to their customer, the NHS.
This element of privatisation, in my opinion, is seriously undermining the efficiency of front-line medical provision.
I work in cancer care in the NHS. I agree that health promotion should be prioritised as much as disease treatment. We are in a period of huge innovation in cancer treatments that are improving cure and survival rates but I do sometimes wonder if the marginal benefits in terms of survival are worth the cost. If what we can spend is finite then quality of life improvement may be a better target for spending than relatively small lifespan extensions at any cost. This is tricky though. Many people are surviving for many more years. And for shorter extra survival, many people reaching the end of their life seem to value the extra months and weeks they can spend with their friends and family, value just being alive despite the costs in terms of side effects and time spent at hospital appointments. The figures around iatrogenic harm certainly sound alarming. I’d be interested in reading your sources for the iatrogenic harm figures in your post.
The influence on my cacer thinking is my wife – now 12 years post truly disastrous cancer treatment (the cancer did, indeed, go with the op). The reuslt of all her research is that there are better ways to manage recurrence with likely better outcomes.
There is a lot of research on iatrogenic harm here and in the USA. Start here https://www.bmj.com/company/%20newsroom/237-million-medication-errors-made-every-year-in-england/
That said, estimates vary widely depending on definitions, reporting practices, and study methods, and some headline figures (e.g., “third leading cause of death”) are debated within the literature.
Thanks Richard,
I’ll take a look at the article.
Concerning the possibility we are overtreating for cancer, I have mixed thoughts. We do give quite a bit of maintenance therapy even after disease is no longer measurable but my understanding is that this is in line with best available evidence for limiting recurrence. However, I do not routinely read the original trials and I give treatments mostly based on trust in the medical team.
There are a significant number of people with blood cancers to whom we give no treatment. In some cases the side effects are thought to outweigh the benefits. Sometimes the effectiveness of treatment is thought to be better saved for later in the course of the disease so that the patient does not develop resistance to the drugs during a time when treatment is not urgent.
People can be surprised to hear that they have cancer but that they are not going to get any treatment for it.
I think this may be the problem:
“I do not routinely read the original trials and I give treatments mostly based on trust in the medical team.”
Read Ivan Illich’s classic critique, Medical Nemesis, on iatrogenic medical health systems.. starts with the story of when the death rate went down during a doctors strike. Check out the 1930s Peckham health experiment as a GP led holistic community health building example. Check out the Blackthorn GP practice in Maidstone where a whole range of activities helps thick file chronic patients? How can we build on the good examples?
Thank you for your reflection, Professor Murphy. I wonder if you are familiar with Ivan Illich’s Medical Nemesis, a book in which he argues that the modern medical establishment itself has become a major threat to health through “iatrogenesis”—doctor-caused harm, from clinical errors (clinical iatrogenesis) to the over-medicalization of life (social/cultural iatrogenesis) that strips individuals of self-care, turning health into a commodity and creating dependence on a system that actually fosters sickness and disables people, rather than truly empowering them.
I m not. My wife, and medical adviser, is. Thanks.
You can also blame the DWP assessments for PIP and ESA requiring evidence for the most stupid of things just you prove you are qualifiable for the benefit. you need GP letters consultant notes, got osteoarthritis prove it, type of thing. It blocks up so much of the nhs time just so the DWP can make there system just that little bit more nasty.
Hi Richard,
I am a 38 year old & I have been overweight (& then obese), literally since the day I was born. I was the maternity’s record weight newborn at the time! I have tried all lifestyle interventions you are mentioning & taken Ozempic (spoiler, it did not work, I am still fat). My parents are in their mid 70s have between them diabetes, heart disease & my mum had bowel cancer – they both take a bucketload of meds.
I agree with you that prevention is key. I also agree with you that there is something about our food system that is doing us harm (but I don’t think we quite know what it is!). And the result of that is more chronic disease patients in the NHS, that pharma is milking for profits. And I agree that some interventions (statins) are pointless. But I think that is where our agreement ends…
1. Cancer treatments – no surgeon can ever guarantee they’ve identified and taken all of your cancer out. We don’t have the imaging technology to know for sure! That’s why you have follow on chemo / radio – to make sure any remaining cancer cells are killed. The treatment is gruelling, but the alternative is constant uncertainty & checks to catch the recurrence again. My mum, like many cancer patients took the preventative chemo over the mental anguish. Also, doctors probably don’t have the time to do the frequent screening instead of the chemo to catch re-occurence.
2. The data behind lifestyle changes ‘curing’ things like diabetes is even shoddier than the data supporting statins. It may not be immediatelly obvious, but a lot of that research is based on:
a) statistical manipulation of a few large epidemiological datasets
b) that were unreliable to start with – i.e. it was based on food recall questionnaires, rather than actually recording people’s diets. These are notoriously unreliable – try ‘recalling’ what you ate last week, or last month and assess just how reliable you can be.
P-hacking – in layman’s terms, collecting large number of variables for a dataset, and massaging it until it gives you a ‘statistically significant’ result , is rife in nutrition research & lifestyle interventions and chronic disease research. Of course, ‘statistically significant’ does not equal real worlds significant.
[Running out of words – I will continue in a second post]
[Part 2]
3. Diabetes – The prices of insulin went up post Pandemic, prompting the NHS to promote basically extreme dieting as a way to ‘put diabetes into remission’ and cut costs. Note that their website rarely says ‘cure’ diabetes – words matter! The studies supporting that are here – https://www.england.nhs.uk/diabetes/treatment-care/diabetes-remission/. You will note they involve putting diabetics on very low calorie unsustainable diets. You’ll also note that the moment they stop the insane dieting, in the follow up studies, most participants’ blood sugar is back up again. This is a very cruel sticking plaster over a problem we scientifically don’t understand. Diabetics deserve better, including a good quality of life that does not involve starving all the time. If insulin gives them that – so be it!
4. There is over-optimism with regards to how much lifestyle changes can achieve. I daresay more so in the older generations, who had an easier time maintaining their weight vs the younger generations, who have struggled from earlier ages, tried it all and never got anywhere. There is a ‘healthy weight’ divide, just like there is a ‘how hard was it to buy a house’ divide between generations, that is rarely acknowledged.
So to sum up –
– I think we need to put more money into exploratory, empirical research into obesity & chronic diseases and stop relying on flimsy epidemiology to recommend diet and exercise interventions. That research should inform prevention strategy, to reduce the burden of chronic disease on NHS.
– We should have more empathy towards the fat & the chronically ill. What if it is not their fault? Just because certain aspects of lifestyle are *correlated* with obesity & chronic disease, does not mean they have *caused* it. The science on this topic is a lot flimsier than people assume!
– We should stop expecting personal responsibility for health, when it is clear that the problems are systemic (like UPF). Our focus should be on making healthy food available in every restaurant, take away & shop. This is to make the ‘healthy option’, whichever way defined, the default option, for everyone, regardless of income or how busy they are. Personal responsibility has a place in health – it comes after governments & companies have exercised their responsibilities.
If you are interested in this topic, happy to share various resources, podcasts, etc.
Thanks.
Noted and I agree with this:
“We should have more empathy towards the fat & the chronically ill. What if it is not their fault? ”
My whole point is, it is not.